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58 Cards in this Set
- Front
- Back
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What percentage of an adult's total body weight is water?
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60%
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What is there more of ICF or ECF?
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ICF is 2/3 of this water
ECF is 1/3 of this water |
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What are the major electolytes in ICF?
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potassium K
phosphate PO4 |
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What are the major electrolytes in ECF?
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Sodium Na
Chloride Cl |
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What is the primary determinant of ECF concentration?
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sodium Na
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What are the main types of regulatory mechanisms of fluid between IC compartments and EC compartments?
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Osmosis
Diffusion Filtration Active Transport |
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Give an explanation of Osmosis.
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Osmosis involves fluid shifting through membranes from an area of low solute concentration to an area of higher solute concentration in an attempt to achieve physiologic balance (homeostasis).
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Give an explanation of Diffusion
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Diffusion involves fluid movement from an area of high solute concentration to one of lower solute concentration.
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Give an explanation of Filtration.
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Filtration referes to movement of fluid and electrolytes out of solution in response for example to hydrostatic pressure of circulating blood (ie: pressure of blood pushes fluids and electrolytes out of the vasculature and into the interstitial spaces)
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Give an explanation of active transport.
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Requires energy and it transports ions across the cell membrane against a concentration gradient. (Sodium Potassium Pump)
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When does fluid loss happen in adults?
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constantly as a result of normal body functions
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What is the normal fluid output of the kidneys on a daily basis?
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1 to 2 L a day
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From the skin, sensible losses normally range from ______ to _______ mL/hour depending on temperature.
What does this amount to in a day? |
0 to 1000 mL/hour
Equal to 600mL/day which can increase with fever |
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From the lungs, there is this type of fluid loss.
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insensible loss (exhaled water vapor)
Amount is about 400mL/day which increases with fever |
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What are the normal daily losses of fluid from the GI tract?
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100 to 200mL/day
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List the sources of fluid loss
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kidneys
lungs gi tract skin |
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What are the mechanisms to achieve homeostatic balance of fluid and electrolytes in the body?
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1. kidneys
2. cardiovascular system 3. lungs 4. buffers 5. pituitary gland 6. adrenal cortex 7. parathyroid glands |
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How long does it take for the kidneys to regulate acid/base?
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a few hours to several days
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How is the cardiovascular system involved in fluid/electrolyte & acid/base balance?
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cardiovascular system maintains adequate renal perfussion.
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What is the most powerful respiratory stimulant?
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partial pressure of CO2. If it is up, you will increase rate and depth.
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What is the most powerful respiratory stimulant?
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partial pressure of CO2. If it is up, you will increase rate and depth.
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What are buffers?
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chemical systems that maintain body pH (acid/base balance) by inactivating or releasing hydrogen ions.
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What is the main buffer system?
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bicarbonate-carbonic acid
HCO3 to H2CO3 |
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How is the pituitary gland involved in fluid/electrolyte balance?
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The pituitary gland releases antidiuretic hormone (ADH) which promotes water retention.
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How is the adrenal gland involved in fluid/electrolyte balance?
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The adrenal gland produces aldosterone, which causes sodium retention and potassium loss.
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How is the parathyroid gland involved in fluid/electrolyte balance?
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it secretes parathyroid hormone which regulates calcium and phosphate balance.
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How do you evaluate an acid-base balance?
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through arterial blood gas analysis (ABGs)
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What are the six components of ABG?
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pH
PaCo2 PaO2 oxygen sat (o2Sat) base excess bicarbonate HCO3 |
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The partial pressure of carbon dioxide in arterial blood is normally ___________. If it is increased, it is because the patient is -----ventilating. If partial pressure of Co2 is decreased, it is because the patient is ------ventilating.
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35-45
co2 increased b/c patient is hypoventilating co2 decreased b/c patient is hyperventilating |
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In general respiratory acidosis is caused from....
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HYPOventilation. Their pH is dropping. Increased H in blood because they are not blowing off H. Normally it would be blown off with carbonic acid...but not breathing off enough CO2 or H. So pH is going down, CO2 level rising. Respiratory Acidosis
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In general respiratory alkalosis means the patient is breathing like this...
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hyperventilating. Breathing fast. Blowing off tons of CO2, and Tons of H, so pH is rising. Bicarbonate level is low (HCO3). pH level is above 7.45
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Give a couple of examples of respiratory alkalosis.
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asthma** - hypoxia
pneumonia inappropriate mechanical ventilator settings** anxiety** hypermetabolic states (fever, exercise, sepsis)** head injuries salicylate overdose** **can be from primary respiratory problems or from factors outside of respiratory system |
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Give a couple examples of respiratory acidosis
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atelectasis (obstruction of small airways by mucus)
pneumonia** COPD** respiratory failure head injury obesity drug overdose CNS depressants Narcotis anesthetics** |
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Describe pH rise and fall in relation to hydrogen.
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Increase in H, makes it more acidic...pH goes down below 7.35
Decrease in H makes it more alkalline, pH goes up past 7.45 |
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Primary signs of respiratory acidosis
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rapid, shallow respirations, headache, altered LOC
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What is the nursing managment for respiratory acidosis?
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sodium bicarbonate (b/c bicarbonate is low with acidosis???)
support ventilation correct electrolyte imbalance treat underlying cause |
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Why does hypoxemia occur with respiratory acidosis?
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b/c of respiratory depression
sets the stage for further neurological impairment |
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What is the breathing like with respiratory acidosis?
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hypoventilation....but rapid shallow respirations. Not increased depth.
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With a patient with COPD, why do you not give them O2?
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can't give them too much b/c it will take away their trigger to breathe b/c CO2 is no longer the trigger for them. O2 is th etrigger and if you give them too much O2, there will be no incentive to breath any longer.
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What is hypocapnea and hypercapnea?
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hypocapnea is reduced CO2 in blood (hyperventilation caused)
hypercapnea is increased CO2 in blood (hypoventilation caused) |
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What are the main causes of respiratory alkalosis?
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hyperventilation with anxiety
hypoxia with asthma mechanical overventilation saliclylate overdose hypermetabolic states such as fever and sepsis |
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What are the primary signs of respiratory alkalosis?
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increase in rate and depth of respirations
tachycardia signs of anxiety |
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Hyperventilation has this type of breathing.
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increased rate and depth
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Hypoventilation has this type of breathing.
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increased rate and NOT increased depth
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What is main tx for metabolic alkalosis?
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increase CO2 retention (paper bag, mechanical hypoventilation, calm patient)
treat underlying cause |
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What is a unique characteristic of respiratory alkalosis?
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tingling in extremities
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METABOLIC ACIDOSIS
What is the underlying cause of it? |
loss of bicarbonate
increase of acids gain in acids or loss of base from blood plasma |
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Just to make things confusing, metabolic acidosis has this type of symptom with respirations.
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hyperventilation with deep respirations - first sign
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What are the main causes of metabolic acidosis?
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diabetes mellitus (DKA)
chronic alcoholism severe malnutrition/starvation renal failure |
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What are the primary signs of metabolic acidosis?
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hyperventilation with increased depth of respirations - first sign
altered LOC cardiac arrythmias hypotension anorexia nausea & vomiting |
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What is the tx for metabolic acidosis?
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replace sodium bicarbonate and fluids
treat underlying cause |
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What is the underlying mechanism for metabolic alkalosis?
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loss of hydrogen ions (acids)
a gain in bicarbonate or both |
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What are some causes of metabolic alkalosis?
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hypokalemia
excessive losses from GI tract (vomit/NG drainage) drugs - steroids, diuretics |
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When you think cause of metabolic alkalosis, what do you think?
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potassium loss
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What are some primary signs of metabolic alkalosis?
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slow, shallow respirations
neuromuscular excitability (twitching, cramping, tetany) numbness and tingling of fingers, toes, mouth altered LOC |
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What is tx for metabolic alkalosis?
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replace fluid and electrolytes
treat underlying cause |
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What are the normal levels of the following lab values?
pH PO2 PCO2 |
pH 7.35-7.45
PO2 80-100 mmHg PCO2 35-44 mmHg |
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What are the normal lab values for the following things?
HCO3 Base Excess Oxygen Saturation |
HCO3 22-26 (bicarbonate) - bicarbonate is an alkaline
Base excess =2--2 mEq/L Oxygen saturation 95-99 |
